[Arthrodesis of the wrist in inflammatory arthropathy. Effects of fusion of intracarpal joint spaces on functional results].
We retrospectively analysed 25 wrist arthrodeses performed in 23 patients because of inflammatory joint disease (21 rheumatoid arthritis, 1 case of Still's disease, 1 case of psoriatic arthritis) to assess: 1) the functional result, the position and the fusion rate; 2) the correlation between the radiographic features and the results on pain. The results were evaluated after an average of 56 months (12-121) by an observer not involved in surgery. 8 wrists were pain-free, 12 caused occasional pain, 4 caused frequent pain and 1 wrist was responsible for continuous pain at follow-up. The position of the arthrodesis was acceptable in the sagittal plane (mean extension 4.3 degrees), but with a slight ulnar tilt (mean ulnar tilt 12.8 degrees). Fusion was achieved in all cases after a mean of 8.2 weeks (5-16). All the intracarpal joints had united in only 8 cases, while the scaphotrapezo-trapezoid joint had not united in 17 cases, but fusion was spontaneously obtained in 8 cases. We identified 5 non-unions between lunatum and triquetrum, 5 non-unions between hamatum and capitatum and 3 non-unions between triquetrum and hamatum. Pain at follow-up was related to non-union of triquetro-lunate joints (p = 0.035). Wrist arthrodesis remains appropriate for severe lesions of the rheumatoid wrist in order to restore function and relieve pain.
Chantelot
C
C
Service d'Orthopédie-Traumatologie B, Hôpital B, CHRU de Lille.
Le Coustumer
F
F
Fontaine
C
C
Migaud
H
H
Duquennoy
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D015535:Arthritis, Psoriatic / Q000000981:diagnostic imaging / Q000601:surgery*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000601:surgery*; D001174:Arthrodesis / Q000009:adverse effects / Q000379:methods*; D002348:Carpal Bones / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D016706:Still's Disease, Adult-Onset / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000601:surgery*
Arthrodèses du poignet pour arthropathie inflammatoire. Influence de la fusion des interlignes intra-carpiens sur le résultat fonctionnel.